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The Ebola cases in the United States brought attention to the risks to sanitation workers posed by pathogens in wastewater.

But Ebola is not the biggest threat to those workers’ health, especially since Ebola cases have disappeared from the U.S. and have significantly declined even in Africa.

Instead, the biggest emerging pathogen threat in wastewater is from “super bugs,” bacteria that are resistant to antibiotics, according to Matthew Arduino of the U.S. Centers for Disease Control and Prevention (CDC).

Arduino, an environmental microbiologist, called the risk of Ebola infection “immeasurably small” in the U.S. today. He noted that the mere presence of Ebola or any pathogen in the environment does not equal risk. Instead, risk exists where the pathogen:

Has a route of escape from its host

Is viable and virulent enough to cause disease

Is present in large enough concentration

Has a mode of transmission to a new host

Has a portal of entry (through a cut, inhalation, or other means)

Reaches a host that is susceptible

Arduino noted that many pathogens – bacteria, viruses and parasites – are present in wastewater, but that the Ebola threat is tiny compared to that of the “super bugs.” He cited data showing that in the general population, antibiotic-resistant bacteria infected some 2 million people in the U.S. last year, of whom 23,000 died. Meanwhile, there were only 12 cases of Ebola, leading to one death.

He emphasized that the only proven source of Ebola transmission is contact with the blood or body fluids of symptomatic patients. The virus is present in urine and feces only in the minority of cases, he observed. He characterized influenza, measles and hepatitis B as “much more infectious” than Ebola. In the U.S., no person outside health care settings has developed Ebola disease.

While the Ebola virus in wastewater does not multiply and has limited survival time, the “super bugs” can reproduce in wastewater and can even proliferate in drain systems. Arduino said more research is needed to determine the risks posed by these organisms.

Meanwhile, he said, workers should heed the CDC’s basic advice for helping to protect themselves against any and all pathogens:

Wear appropriate personal protective equipment including goggles or a face shield, impermeable coveralls, waterproof gloves and rubber boots when working around sewage.

Observe good basic hygiene such as washing hands, removing soiled clothing and having it laundered at work, eating in areas away from wastewater, and avoiding touching the face, mouth and eyes after working with wastewater.